Specimen

Normal findings

Description

Cytology is the study of the origin, structure, function, and pathology of cells. In clinical practice, cytological examinations are generally performed to detect cell changes resulting from neoplastic or inflammatory conditions. Cells from the epithelial lining of the urinary tract can be found in the urine. Examination of these cells for abnormalities is useful with suspected infection, inflammatory conditions, or malignancy.

This procedure is contraindicated for

N/A

Indications

Assist in the diagnosis of urinary tract diseases, such as cancer, cytomegalovirus infection, and other inflammatory conditions

Critical findings

It is essential that a critical finding be communicated immediately to the requesting health-care provider (HCP). A listing of these findings varies among facilities.

Timely notification of a critical finding for lab or diagnostic studies is a role expectation of the professional nurse. Notification processes will vary among facilities. Upon receipt of the critical value the information should be read back to the caller to verify accuracy. Most policies require immediate notification of the primary HCP, Hospitalist, or on-call HCP. Reported information includes the patient’s name, unique identifiers, critical value, name of the person giving the report, and name of the person receiving the report. Documentation of notification should be made in the medical record with the name of the HCP notified, time and date of notification, and any orders received. Any delay in a timely report of a critical finding may require completion of a notification form with review by Risk Management.

Interfering factors

N/A

Nursing Implications and Procedure

Pretest

Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.

Patient Teaching: Inform the patient this test can assist in identification of the organism causing infection or the presence of a tumor in the urinary tract.

Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex.

Obtain a history of the patient’s genitourinary and immune systems, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.

Review the procedure with the patient. If a catheterized specimen is to be collected, explain this procedure to the patient and obtain a catheterization tray. Address concerns about pain and explain that there may be some discomfort during the catheterization.

Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.

Note that there are no food, fluid, or medication restrictions, unless by medical direction.

Intratest

Potential complications: N/A

Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.

Instruct the patient to cooperate fully and to follow directions.

Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate tubes with the corresponding patient demographics, date and time of collection, method of specimen collection, and any medications the patient has taken that may interfere with test results (e.g., antibiotics).

Clean-Catch Specimen

Instruct the male patient to (1) thoroughly wash his hands, (2) cleanse the meatus, (3) void a small amount into the toilet, and (4) void directly into the specimen container.

Instruct the female patient to (1) thoroughly wash her hands; (2) cleanse the labia from front to back; (3) while keeping the labia separated, void a small amount into the toilet; and (4) without interrupting the urine stream, void directly into the specimen container.

Pediatric Urine Collector

Put on gloves. Appropriately cleanse the genital area, and allow the area to dry. Remove the covering over the adhesive strips on the collector bag and apply over the genital area. Diaper the child. After obtaining the specimen, place the entire collection bag in a sterile urine container.

Indwelling Catheter

Put on gloves. Empty drainage tube of urine. It may be necessary to clamp off the catheter for 15 to 30 min before specimen collection. Cleanse specimen port with antiseptic swab, and then aspirate 5 mL of urine with a 21- to 25-gauge needle and syringe. Transfer urine to a sterile container.

Urinary Catheterization

Place female patient in lithotomy position or male patient in supine position. Using sterile technique, open the straight urinary catheterization kit and perform urinary catheterization. Place the retained urine in a sterile specimen container.

Suprapubic Aspiration

Place the patient in supine position. Cleanse the area with antiseptic, and drape with sterile drapes. A needle is inserted through the skin into the bladder. A syringe attached to the needle is used to aspirate the urine sample. The needle is then removed and a sterile dressing is applied to the site. Place the sterile sample in a sterile specimen container.

Do not collect urine from the pouch from a patient with a urinary diversion (e.g., ileal conduit). Instead perform catheterization through the stoma.

General

Promptly transport the specimen to the laboratory for processing and analysis. If a delay in transport is expected, add an equal volume of 50% alcohol to the specimen as a preservative.

Post-Test

Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.

Instruct the patient to resume usual medication as directed by the HCP.

Instruct the patient to report symptoms such as pain related to tissue inflammation, pain or irritation during void, bladder spasms, or alterations in urinary elimination.

Observe for signs of inflammation if the specimen is obtained by suprapubic aspiration.

Administer antibiotic therapy as ordered. Remind the patient of the importance of completing the entire course of antibiotic therapy, even if signs and symptoms disappear before completion of therapy.

Recognize anxiety related to test results, and be supportive of fear of shortened life expectancy. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate. Educate the patient regarding access to counseling services.

Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.

Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

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